Health anxiety, also referred to as hypochondria, is not a new phenomenon.
Since the dawn of medicine (and undoubtedly before it), people with and without medical conditions have worried about their health and the prospect of illness. And in people with health anxiety, this worry might develop to a point where it becomes a health issue in its own right.
It goes without saying that information relating to health and illness has become much more readily accessible, since the internet became a household commodity.
For many, particularly those living with chronic conditions, the internet can be an incredibly useful tool. It enables them to find specialist support groups, charities and organisations which can offer help and advice on their particular condition (or that of a loved one). It can also serve as a helpful resource for people wanting to improve their general health through lifestyle change, and learn more about nutrition and exercise.
But access to very detailed information on illnesses, some of which may be serious but also quite rare, has exacerbated matters for those prone to health anxiety, and given rise to a new form of it: cyberchondria.
As we’ll discuss in this article, cyberchondria is a growing concern among healthcare professionals. Here, we’ll outline what the term means, and how you can find support if you think you might have health anxiety.
Cyberchondria (or internet print-out syndrome)
Back in 2001, the BBC reported that doctors were being faced with a new condition, called cyberchondria or ‘internet print-out syndrome’. The piece described how patients with cyberchondria would look up their symptoms online, then approach their doctor with a predetermined idea of the condition they were (convinced they were) suffering from.
GP Dr Trefor Roscoe at the time (rightly) predicted that cyberchondria would become more common as internet use increased.
In 2008, a study by Ryen White and Eric Horvitz published in the Association for Computing Machinery’s Transactions on Information Systems journal (or TOIS) referred to cyberchondria as:
- ‘the unfounded escalation of concerns about symptomatology, based on the review of search results and literature on the Web’.
In a subsequent paper presented at the AMIA Annual Symposium in 2009, the authors said that people searching for common symptoms may be faced with results or content about serious illnesses that caused alarm; and that this content might not provide information on the likelihood of these serious illnesses being present, or the possibility that symptoms could have a benign cause.
Some of the findings of their research, surveying over 500 participants, were that:
- escalation of health concerns based on web searches occurred frequently (which they defined as ‘always’ or ‘often’ responses) in approximately one in five people;
- web-based interactions increased health anxiety in two in five people;
- and that web-based interactions lowered health anxiety in half of people.
They added that other factors, such as how prone someone is to anxiety and their anxiety levels in general could also be contributory to this.
In their introduction, they noted that previous studies had shown that:
- 80 percent of American adults had searched for healthcare information online,
- but 75 percent did not undertake checks to ensure that the information was valid and accurate, such as verifying the source.
Why is it such a problem?
For a patient, health anxiety can become a cyclical process.
For instance, worrying about the symptoms of a serious condition can lead someone to become much more conscious of small (and often inconsequential) symptoms when they occur. This might be a headache, or a small skin blemish, or a dull pain in a muscle. Symptoms such as these may be due to any number of reasons, but if someone associates them with serious illness, then they might start to worry about them more.
This worry might then make them stressed, causing more headaches or muscle pain; which then leads to more worry, and so on.
People with health anxiety will often look for reassurance from a doctor, or from internet sources. When they receive assurance, this might only be temporary until they notice something else and become convinced of a different problem.
It's also possible that someone with health anxiety might do the exact opposite, and go out of their way to avoid contact with doctors, nurses or healthcare professionals, or any information or activities relating to health.
Health anxiety can escalate and lead to problems such as depression, or panic attacks; so it should be addressed. GPs can offer support, and refer patients to a therapist where appropriate.
Cognitive behavioural therapy, or CBT, is one form of treatment therapists use to help people with health anxiety. Recently, researchers from Imperial College London and King’s College London conducted a study into the use of CBT in 444 patients with health anxiety, and found it to be an effective treatment.
In other cases, therapists may use other forms of treatment, such as trauma therapy, if CBT is not suitable.
For health services and GPs, health anxiety has been identified as a problem due to the sheer time and resources it consumes. A patient with health anxiety may book appointments and be sent for tests which, ultimately, aren’t required.
Emeritus Professor of Community Psychiatry at ICL, Peter Tyrer, recently estimated that the yearly cost to the NHS of untreated patients going in for tests and appointments which weren’t necessary could be up to £56m.
So, for healthcare providers, tackling the issue of health anxiety and cyberchondria is important, as it will help to reduce unnecessary contact and free up resources.
How do I know if I have health anxiety?
A doctor or therapist might typically assess someone’s behaviours and ask them questions, and try to identify whether they have health anxiety based on their answers.
First developed by Issy Pilowsky in his 1967 essay, Dimensions of hypochondriasis, the Whiteley Index is a test which has been used in some studies (such as this one published in BMJ Open) to measure health anxiety. It consists of several questions around the patient’s attitude to illness (for instance: ‘Do you worry a lot about your health?’ and ‘Are you afraid of illness?’) and the patient is scored based on their answers. There is no hard cutoff score which indicates that health anxiety is definitely present, but someone with a high score might be said to be experiencing the issue.
The NHS Choices entry on hypochondria and the Anxiety UK page on health anxiety both carry a much simpler test, simply stating that if a patient mostly answers ‘yes’ to six questions (such as ‘Have you been preoccupied with having a serious illness because of body symptoms, which has lasted at least six months?’ and ‘Have you needed to carry out constant self-examination and self-diagnosis?’), they may profit from discussing their anxiety with their doctor.
The Northumberland, Tyne and Wear NHS Foundation Trust have also developed an information and self-help guide, which may be of use to patients who are concerned about health anxiety.
Getting health information online
Before using the internet to find information on health, it’s important to consider:
- whether you think you may have or be prone to health anxiety;
- what sort of information you’re looking for;
- and where you can find reliable, balanced information.
If you think you may have health anxiety, then searching for information on symptoms or illnesses online risks making your anxiety worse. Entering non-specific symptoms into search engines in particular may provide results which, in some cases, cause unnecessary alarm.
In a recent study titled Cyberchondria: Parsing Health Anxiety From Online Behavior, Emily Doherty-Torstrick and colleagues tested 731 subjects who ‘endorsed’ online symptoms checking. It found that people with moderate to high levels of anxiety experienced more anxiety during and after searching. This, they said, suggested ‘that individuals with illness anxiety should be advised to avoid using the Internet for illness-related information’.
On the other hand, if you are not prone to health anxiety, then seeking more information about a symptom from a reliable resource such as NHS Choices may help to put your mind at rest (or, as may be the case, prompt you to seek the medical advice you need). But it’s important to exercise caution, and consider speaking to someone if this becomes a frequent habit.
As we’ve already discussed, if you’re not symptom-checking, and looking for information on making positive lifestyle changes (such as nutrition or exercise), then the internet can be a useful resource, provided you know where to look. It can also be helpful to people who have already been diagnosed with a condition, and want to find out more about the support organisations or services available.
If you are looking for this sort of information, there are some checks you can make to ensure that the website you’re getting it from is a reputable source.
For instance, sites bearing the Information Standard logo undergo assessment by NHS England to ensure they provide accurate and balanced information. Sites regulated by the CQC are also subject to checks to make sure the information they provide is accurate.
Take a look at the site and the people running it. You can also look to see whether the site has an editorial policy in place, or is curated by a doctor or healthcare professional.
If the site you’re looking at is open source, such as a forum, then check to see if it is moderated or hosted by a reputable organisation. It’s important to keep in mind that information posted on forums may not always have been screened by a medically-qualified person.